Public health threats can affect air quality, cause
shortages of safe water and food, and cut off electricity, gas, telephone, and
other services. You and your family members may be separated.

Disasters are hard to predict and usually are out of your control. But
you can take steps to help keep you and your family safe.

Preparing for disaster

Here are some things you can
do to help prepare for a disaster:

Learn about specific health threats and what
you can do to reduce the risk to your health and safety. This topic helps you
understand how health hazards can spread through a community and how you can
limit your exposure to them.

Make an emergency plan and gather the
supplies you may need during an emergency. This topic includes tips on making
an emergency plan and a supplies kit.

Learn basic first aid skills
such as CPR. And know where to find first aid information in case of injuries.
For example, you can keep a first aid book in your emergency supplies
kit.

Always look to local authorities and health experts for
specific, up-to-date information for your area. Follow their advice, even if it
differs from this topic.

Following these steps can help you be better prepared for
any type of public health threat.

Health threats in your community

There are many
things in our environment that can be harmful. Chemicals, fumes, viruses,
bacteria, and low-level radiation are just a few of them. When these substances
are released in large quantities or get out of control, they can become urgent
public health threats. Guidelines for how to prepare for and avoid a problem
often depend on how the substance is spread.

In general, a health
threat may spread through a community:

In the air.

In the water supply
or food.

From human to human.

From animal or insect to
human.

Call your local health department for information about
health threats in your area.

Air Contamination

Chemicals are the most likely
source of air contamination. An accident at a plant or factory or a train wreck
might release large amounts of a hazardous chemical into the air, for instance.
A terrorist attack could involve the deliberate release of a toxic chemical or
gas.

In a bioterror attack, bacteria or viruses causing diseases
such as
anthrax,
pneumonic plague,
smallpox, or
tularemia could be released in an aerosol form. Anyone
who inhaled the substance could be affected.

Although air itself
does not become radioactive, the release of radiation into the environment can
create radioactive dust and dirt (fallout) that can make the air unsafe. A
"dirty bomb" could work in this manner, causing a relatively minor explosion
but doing its real damage by releasing radioactive materials into the
environment.

What you can do

You cannot do much in advance to
protect yourself from a hazardous substance released into the air. If there
hasn't been an obvious explosion or a known terrorist attack, the air could
become contaminated without anyone knowing it until people or animals start to
develop symptoms.

As with other potential emergencies, it makes
sense to have a disaster kit with water, food, first aid items, tools, and
other essentials. Concern over terrorist threats has prompted some people to
consider adding the following items to their supplies:

Duct tape and plastic sheeting for
"sheltering in place."
Sheltering in place involves temporarily sealing
yourself inside a room in your home or another indoor location and shutting off
sources of ventilation so that outside air doesn't get in.

Masks.
In general, masks are helpful only if you know how and when to use them and if
they are properly fitted. They are not recommended for the general public. You
do not need to purchase or wear any kind of protective mask unless civil or
health authorities in your area tell you to do so.

Potassium iodide tablets. Potassium iodide, also known as KI,
helps protect your thyroid gland from the harmful effects of radioactive
iodine, which could be released as a result of a dirty bomb, an explosion at a
nuclear power plant, or any other nuclear incident. The KI is taken up by your thyroid gland and prevents the radioactive iodine from accumulating there. Potassium iodide does not protect against any other radioactive substances.

Vaccines for anthrax and smallpox are available for
certain high-risk groups but are not recommended for the general public at this
time. In 2007, the U.S. Food and Drug Administration (FDA) approved the first
vaccine for humans against bird flu (avian influenza). Immunization is not currently recommended for the public.
The vaccine will be kept in the U.S. government stockpile.1 For more information, see the Bioterrorism and Vaccinations
section of this topic.

If a hazardous substance is released into
the environment:

Get out of the immediate area if possible. If
the release has occurred outdoors, go inside. If it has occurred indoors, go
outside. Move out of low-lying spots to higher ground, because most chemicals
released into the environment are heavier than air and will
sink.

Tune into a local radio or TV station for instructions from
public health and emergency officials. Phone lines are likely to be overwhelmed
during a public health emergency. So do not try to call for instructions.
Information also may be available over the Internet. Depending on the kind of
release, authorities may advise you to shelter in place or simply to stay
indoors. You do not need to leave your community unless local authorities tell
you to.

If you are directly exposed to radioactive dust, dirt, or
other fallout, follow the steps for
personal decontamination to get the substance off your
skin as quickly and completely as possible.

Do not take potassium
iodide (KI) tablets unless local authorities tell you to. These tablets are
effective against radioactive iodine only, and they can be harmful if taken
improperly.

Food and Water Contamination

Chemicals, heavy metals
like lead and mercury, and living organisms such as bacteria and viruses can
all be threats to a safe water supply. These substances can also contaminate
food.

Unintentional contamination of water as a result of chemical
leaks or spills, natural disasters, and other causes has been a much bigger
problem than deliberate contamination. Likewise, accidental food contamination
by botulinum toxin (the agent that causes
botulism),
E. coli, and other harmful
organisms during the storage or preparation of food is much more likely than
intentional food poisoning.

Intentional poisoning of food and
water has occurred, though. The use of food and water to expose people to
biological or chemical weapons is also possible. Terrorists could release
living organisms such as the bacteria that cause
tularemia or botulism into the water or food supply.
Hazardous chemicals could be deliberately released in liquid or solid form.
Radioactive materials could be released into the water.

What you can do

With the exception of a known
accident (such as a chemical spill into the water supply) or an announced
terrorist or criminal incident, you probably would not know that you had
consumed contaminated water or food unless you developed symptoms. To reduce
your risk of consuming contaminated food or water and to be better prepared for
public health emergencies affecting the water supply:

Don't eat food or drink water or any other
beverage that looks or smells suspicious. In general, it is not a good idea to
eat or drink something when you don't know who has prepared or provided it or
where it has come from.

When shopping, avoid food or beverage items
that look like they may have been tampered with—for instance, if the seal is
broken or you think that the container or packaging has been
opened.

Remember that most cases of food poisoning, including
botulism, happen by accident. Follow guidelines for preparing and cooking food
safely, keeping your kitchen clean, and washing your hands and utensils. If you
preserve and can foods at home, learn and follow proper canning and freezing
techniques to ensure safety. Discard cans or jars with bulging lids or
leaks.

Know where your household’s water comes from. Is it from the
city water supply? Most public water supplies are carefully monitored and
treated to guard against contamination. Does a private well supply your water?
Private water supplies are unlikely to be targets of intentional contamination.
But they can become contaminated by accident and may not be as closely
monitored as city water supplies.

Learn
how to purify water. And make sure that you include the supplies for this in
your emergency kit. Knowing how to purify water is useful in any situation
where you have to rely on untreated water.

If there is an emergency affecting the water
supply:

Follow all instructions from local
authorities about
purifying your water (commonly called "boil orders")
or using other water sources until authorities notify your community that it is
safe to drink from the regular water supply again.

Do not strictly
ration
emergency drinking water supplies. Try not to waste
any water, but drink what you need. On average, a person needs about
2 qt (2 L) of water a day.
Individual water needs vary depending on age, health, diet, and climate. Learn
the signs of
dehydration in children and
adults so that you know what to watch
for.

Use the safest water you have first before turning to other
water sources.

If you know or suspect that your skin has come in
direct contact with water that has been contaminated by a hazardous chemical or
radiation fallout, follow the steps for
personal decontamination to get the substance off your
body as completely and quickly as possible.

Disease Transmission From Humans, Animals, and Insects

Some bacteria, viruses, and other biological agents can be spread from
person to person or from animals or insects to people. The ease of
international travel has made many of these health threats more difficult to
contain. Recent health threats such as SARS (severe acute respiratory
syndrome), the
West Nile virus, and monkeypox have made people more
aware of how easily disease can spread not only within a community but from one
community to the next.

With some exceptions such as
smallpox and
pneumonic plague, which are contagious diseases, most
biological agents that could be used as bioterror weapons are not spread from
person to person.

The U.S. Centers for Disease Control and
Prevention (CDC) and the World Health Organization (WHO) have current, reliable
information on communicable diseases and health concerns throughout the world.
For updates on specific health emergencies, visit their websites:

www.cdc.gov

www.who.int/en

www.pandemicflu.gov

What you can do

To reduce your chances of being
infected with or spreading a contagious disease:

Wash your hands with soap and water
frequently, especially if you live with or come into contact with someone who
is sick.

Do not share bedding, towels, utensils, or other items
with someone who is sick or, if you are sick, with anyone
else.

Avoid exposure to disease-carrying animals and insects if you
are in an area where these are a problem.

Follow the advice of
local health authorities if there has been a disease outbreak in your community
or in an area where you are traveling. It is especially important to follow
health experts’ instructions if you live or work with someone who becomes sick.
For instance, you may be advised to wear a properly fitted surgical mask if you
are in close contact with someone who has a serious contagious illness, such as
SARS.

If there is an outbreak of a contagious disease in your area,
do not leave the area unless authorities tell you to. If you have already been
infected, you may spread the disease. Leaving the area may also cause a delay
in your diagnosis or treatment.

Also see the Bioterrorism and Vaccinations section of
this topic. A vaccine for smallpox is available for certain high-risk groups
but is not recommended for the general public at this time.

Bioterrorism and Vaccinations

The U.S. Centers for
Disease Control and Prevention (CDC) has developed plans on how to respond to
bioterrorism threats. Certain diseases have been identified as posing the
greatest threat. These diseases are:

Although the CDC is addressing all of these potential
threats, vaccines are available only for anthrax and smallpox. Currently these
vaccines are not recommended for the general public. But the CDC has advised
special vaccinations for people at high risk for exposure to anthrax or
smallpox, such as certain health care workers or military personnel. For more
information, see:

Anthrax vaccination recommendations. The anthrax
vaccine is given in a series of shots (injections) over 18 months. Booster
shots are needed each year thereafter for continued
protection.

Getting Organized

A little organization can go a
long way towards helping you feel ready to handle the unexpected. Having an
emergency plan and an emergency supplies kit for your household can help you
and your family be better prepared for any kind of disaster.

Developing an emergency plan

Putting together an
emergency plan is easy:

Choose a friend or relative as a contact
person for family members to call if they are separated during a disaster. It
is best to choose an out-of-state contact. Make sure every member of your
household has the contact’s phone number. Email may also be a good way to get
in touch.

Pick a place to meet outside your neighborhood in case
you cannot return home. Make sure every member of your household has the
address and phone number. (Also designate a place to meet just outside your
home—a neighbor’s front yard, for instance—in case there is a fire in your
home.)

Write down where and how to turn off the water, gas, and
electricity to the house. Make sure you have any special tools this requires,
such as a T-wrench for the water line.

Discuss what you would do if
you had to leave your home and the area. Include your pets in your plans. Most
emergency shelters and health facilities will not accept
animals.

Keep important documents, such as birth certificates,
marriage licenses, wills, insurance forms, telephone numbers you might need,
and credit card information together and readily available in case you need to
quickly evacuate your home.

You may have other things that you want to include,
especially if you have children in school or if anyone in your household has
special needs. Review your plan yearly, and make sure that phone numbers,
email addresses, and other items are still current.

Assembling an emergency supplies kit

The
essentials of an emergency kit are the same no matter what the situation:
food and water, first aid supplies and medicines, blankets and clothing,
special-needs items (such as baby formula), and certain tools and household
items, including a battery-powered radio, a flashlight, and extra
batteries.

Visit the American Red Cross’s website at
www.redcross.org for a checklist to use as you gather supplies. Store
everything in one place, preferably a cool, dark location. Consider putting
together a smaller version of your emergency kit that you could take if you had
to leave home or
shelter in place.

After you've assembled
your emergency supplies, remember to check and replace them
periodically:

Bottled water that has remained sealed and
unopened needs to be replaced once a year. Water in containers that you filled
yourself needs to be replaced every 6 months.

Follow the Red
Cross’s guidelines (www.redcross.org) on how often to replace food supplies.
Even "nonperishable" items may need to be replaced.

Remember that
both nonprescription and prescription medicines have expiration dates.

Information on disaster readiness

It is hard
to prepare for a terrorist attack because no one knows what form it might take
or when or where it may occur. But being prepared for general
emergencies—including fires, natural disasters, power failures, fresh-water
shortages, and similar events—makes sense and will help to reassure you and
your family.

The following agencies provide extensive information
about disaster planning and terrorism:

The American Red Cross
has developed specific disaster readiness guidelines, including instructions on
how to build a disaster supplies kit and how to make a disaster plan. You can
access this information at www.redcross.org.

The U.S. Federal Emergency Management Agency (FEMA) provides
extensive information about national security emergencies, including chemical,
biological, and nuclear attacks. You can access this information at
www.fema.gov.

The U.S. Centers for Disease Control and Prevention (CDC) provides answers to frequently asked questions
about chemical and biological agents, such as toxic gases and smallpox, and
nuclear attacks as well as advice on how to protect yourself. You can access
this information at www.cdc.gov.

The U.S. Department of Homeland Security urges citizens to be prepared and stay
informed. Many helpful links are available from its website at
www.dhs.gov/dhspublic or at www.ready.gov.

Responding to a Disaster

Dealing with injuries

In any disaster situation,
transportation and communication may be interrupted, and doctors
may be overwhelmed. You may need to evaluate or treat minor or major injuries
or provide first aid, because medical care may not be immediately available.
You may feel more confident when an emergency happens if you know what to do
ahead of time and have resources at hand. The following topics discuss
emergencies that can occur in a disaster situation:

Injuries related to exposure and sanitation

A
natural disaster, industrial accident, or terrorist attack can cause a host of
situations that lead to injury or illness. In some cases your home may need to
be evacuated or may be damaged. A disaster may interrupt water supplies, food
supplies, sewer and trash services, and heat and electricity. You may be
exposed to the elements or have less-than-adequate shelter for a period of
time. The following topics can help you avoid or cope with injuries related to
food safety, sanitation, and exposure:

The topic
Dealing With Emergencies provides more information
about how to cope with injuries that can occur during or right after a
disaster.

Emotional responses

You may feel overwhelmed after
an accident, natural disaster, or terrorist attack. Some people who witness a
traumatic event that seemed life-threatening develop a stress reaction known as
acute stress disorder, which can last up to a month
after the event.

Symptoms include feeling numb, reliving the
event through disturbing memories or dreams, and avoiding anything that may be
a reminder of the event. Symptoms are so intense that they disrupt daily
activities like going to work and interacting with other people.

If the symptoms last more than a month or don't develop until more than a
month after the event, you may have
post-traumatic stress disorder (PTSD). Even if you
were not injured or in danger, you can still get acute stress disorder or PTSD
if you felt physically threatened or witnessed violence. For more information,
see the topic
Post-Traumatic Stress Disorder (PTSD).

People who have experienced or witnessed a traumatic event often need
help from health professionals who are specially trained. If symptoms are
severe enough to disrupt your daily life or do not improve after 2 weeks, talk
with a doctor.

If you lost a loved one or friend in a disaster or
accident (or even a pet, your home, or important possessions), you will need
time to cope with feelings of grief and loss. For more information, see the
topic
Grief and Grieving.

Traumatic events can
also cause feelings of depression that may need treatment. For more
information, see the topic
Depression.

Other Places To Get Help

Organizations

American National Red Cross

2025 E Street NW

Washington, DC

Phone:

1-800-GIVE-LIFE (1-800-448-3543) donation hotline(202) 303-5000

Web Address:

www.redcross.org or www.cruzrojaamericana.org/index.asp
(Spanish)

This Web site has news on what the American Red Cross
is doing in America and around the world. It also has information on disaster
services (for making donations), Red Cross projects, how to volunteer, and
where you can donate time, money, or blood.

The American Red Cross
is one of America's main emergency response groups. It also offers many other
services, such as community services for the needy, support for military
members and their families, and educational programs that promote health and
safety. But the Red Cross is probably best known for its blood drives and
international relief programs.

The American Red Cross is also part
of a worldwide effort that provides care to the victims of war or natural
disasters. This group always aims to prevent and relieve suffering. The Red
Cross is not a government agency. And it relies on donations of time, money,
and blood to do its work.

Centers for Disease Control and Prevention (CDC):
Emergency Preparedness and Response

1600 Clifton Road

Atlanta, GA 30333

Phone:

1-800-CDC-INFO (1-800-232-4636)

Web Address:

http://emergency.cdc.gov

This Web site is intended to help people living in the
United States of America prepare for and respond to public health emergencies.
You can report an emergency, find information on the top emergency resources,
and learn practical tips such as how to assemble an emergency supply kit.

This Web site also has information on bioterrorism, chemical and
radiation emergencies, mass casualties, natural disasters and severe weather,
and recent outbreaks and incidents.

Federal Emergency Management Agency
(FEMA)

500 C Street SW

Washington, DC 20472

Phone:

1-800-621-3362

TDD:

1-800-462-7585

Web Address:

www.fema.gov

FEMA (say "FEE-mah") is part of the United States
Department of Homeland Security. It was created to reduce the loss of life and
property in the U.S. and to protect people from natural or man-made disasters
that happen here, such as acts of terrorism. FEMA aims to do this through a
system of programs to deal with emergency situations.

This Web site
has information about different types of disasters. It lists the states where
the President has declared a disaster. And it tells how individuals and
families can apply for assistance. There are links to other helpful resources,
such as frequently asked questions (FAQs), how to plan ahead, and how to
recover and rebuild.

U.S. Department of Health and Human Services: Disasters
and Emergencies

200 Independence Avenue SW

Washington, DC 20201

Phone:

1-877-696-6775 toll-free(202) 619-0257

Web Address:

www.hhs.gov/disasters/index.html

This Web site of the U.S. Department of Health and Human
Services offers resources on how to plan, prepare, and respond to natural and
man-made disasters. The site has resources for people who have experienced
traumatic events, whether they are survivors, friends and relatives of those
who are hurt or who have died, or rescue workers.

World Health Organization

Avenue Appia 20

1211 Geneva 27, Switzerland

Email:

info@who.int

Web Address:

www.who.int/en

The World Health Organization (WHO) is an agency of the
United Nations. It has about 200 member states. WHO promotes technical
cooperation among nations on health issues, carries out programs to control and
eliminate disease, and strives to improve the quality of human life.

The Web site has information on many health topics, including health and
disease related to travel.

Related Information

References

Citations

U.S. Food and Drug Administration (2007). FDA approves first U.S. vaccine for humans against the avian influenza virus H5N1. FDA News. Available online: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108892.htm.

Other Works Consulted

American Academy of Pediatrics (2006). Chemical-biological terrorism and its impact on children. Pediatrics, 118(3): 1267–1278.

U.S. Food and Drug Administration (2007). FDA approves first U.S. vaccine for humans against the avian influenza virus H5N1. FDA News. Available online: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108892.htm.

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